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ICLP'95 E-MAIL REGISTRATION FORM     Please type, tick your choices,
                                     and return the form WITH YOUR PAYMENT to:
Twelfth International Conference     
on Logic Programming                 Dr. Mutsumi Imai
Shonan Village Center                Keio University at Shonan-Fujisawa
Kanagawa, Japan                      
June 13-18, 1995                     Email: iclp95@tom.sfc.keio.ac.jp
______________________________________________________________________________

Name:       __________________________________________________________________
            (Last)                  (First)                (Middle)

Affiliation:__________________________________________________________________

Address:    __________________________________________________________________

            __________________________________________________________________

Telephone:  ______________________________  Fax:______________________________

E-mail:     ______________________________  ALP Member No.:___________________

Dietary Restriction:  ___None   ___Vegetarian   ___Other (                   )
______________________________________________________________________________
Conference Fee:  before May 15    after May 15
    ALP member:     42,000 yen      48,000 yen (give your member number above)
    Non-member:     45,000 yen      51,000 yen
       Student:     21,000 yen      24,000 yen
Workshop Fee:        3,000 yen (ICLP participants) / 6,000 yen (workshop-only)

I will attend the conference:                             ____________ yen.

I will attend the workshop ___W1 ___W2 ___W3 ___W4 ___W5: ____________ yen.

I will pay the total registration fee of                  ____________ yen by:

 ___Mastercard / ___VISA.  Card Number: ______________________________________

    Cardholder's Name:____________________________ Expiry Date:_______________

    Date:________________________
______________________________________________________________________________
HOUSING REQUEST -- (If you would like us to arrange rooms, please fill in the
items below.  Requests will be processed in the order they are received.)

Arrival Date:_______________ Time:____________ Departure Date:________________

Please reserve 

 ___a single room.

 ___a twin (___Economy/___Standard/___Maisonette) room to be shared with:
    
    (specify name)____________________________ . 

If a room I prefer is not available,

 ___I (___Mr./___Ms.) am willing to share an Economy Twin or Twin room with
    someone else (arrangement will be made by the Organizing Committee).

 ___I would like an upper-class twin room at the Conference Site.

 ___I would like a ___single/___twin room at a hotel outside the Conference
    Site.